VN239 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name and Address) Telephone Number FOR COURT USE ONLY ATTORNEY FOR (Name): PETITIONER RESPONDENT SELF-REPRESENTED SUPERIOR COURT OF CALIFORNIA, COUNTY OF VENTURA 4353 E. Vineyard Avenue Oxnard, CA 93036 Petitioner: ___________________________________________________ Petitioner: ___________________________________________________ CASE NUMBER: STATEMENT OF LEGAL GROUNDS FOR PETITION TO TERMINATE PARENTAL RIGHTS I. Petitioner(s) intends to file/has filed a petition to terminate the parental rights of the natural parent(s) of the prospective adoptive child. The legal grounds upon which the petition to terminate parental rights is to be/has been filed is as follows: II. [Check the appropriate box(es).] Family Code section 7662 Family Code section 7800 et seq. (freedom from parental custody and control) Family Code section 8604 Probate Code section 1516.5 Other ___________________________________________ [identify statute] Dated:__________________________ ________________________________________ Petitioner Optional Form VN239 (7/11) STATEMENT OF LEGAL GROUNDS FOR PETITION TO TERMINATE PARENTAL RIGHTS Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com